Women In Community Action (WICA)

Debutante Program

P.O. Box 2292

Woodbridge, Virginia  22193

RECOMMENDATION FORM (Form must be received by October 10, 2025)

Debutante Program Recommendation Form 2026

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This field is for validation purposes and should be left unchanged.

Debutante Applicant Name(Required)

First Last

Grade(Required)

What is your relationship to the debutante?(Required)

How long have you known the debutante?(Required)

What words come to mind when you think of the applicant?(Required)

Character/ Integrity(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Responsibility(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Interaction with peers(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Interaction with adults(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Concern for others(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Team Player(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Initiative and drive(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Academic Motivation(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Contribution to School(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Contribution to Community(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

Leadership demonstrated(Required)

1-Outstanding

2-Above Average

3-Average

4-Below Average

5-(Unknown)

Please circle the number which best applies to each characteristic: (1-Outstanding; 2-Above Average; 3-Average; 4-Below Average; 5-(Unknown)

How do you think the debutante candidate will benefit from the Women In Community Action (WICA) Debutante Program?(Required)

Additional comments:(Required)

Name(Required)

First Last

Signature(Required)

Title

Business Name

Business Address

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

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Thank you for your time and effort. Be assured that the information you supply will be kept in the strictest confidence. For any questions or concerns, you may call 571-345-5515. Please send the completed form via email to womenincommunityaction1976@gmail.com or in a sealed envelope, sign the flap, and return the envelope to the applicant or mail it to the address below by October 10, 2025.

WICA Debutante Program

17015 Batestown Road

Dumfries, VA  22025